Huang Yujing, Shen Zan, Yao Yang, He Aina, Min Daliu
Department of Oncology, Affiliated Sixth People's Hospital of Shanghai Jiaotong University, Shanghai, People's Republic of China.
Onco Targets Ther. 2021 Jan 11;14:213-220. doi: 10.2147/OTT.S278139. eCollection 2021.
This retrospective study explored the clinical value of the plasma D-dimer level in osteosarcoma.
We measured the plasma D-dimer level before neoadjuvant chemotherapy (D0) and the plasma D-dimer level after four courses of neoadjuvant chemotherapy (D1) in 103 patients with stage-IIB high-grade osteosarcoma of the limb. The change in the D-dimer level (ΔD) was defined as D1 minus D0. The chi-square test was used to compare categorical variables. Analyses of receiver operating characteristic (ROC) curves were undertaken to determine the optimal cutoff points for D0, D1, and ΔD. The area under the ROC (AUC) of D0, D1, and ΔD was calculated to evaluate their discriminatory abilities in monitoring the response to neoadjuvant chemotherapy (tumor necrosis). Survival curves were generated according to Kaplan-Meier analyses and compared using the Log rank test. Univariate analyses and multivariate analyses were carried out to determine independent prognostic factors.
Kaplan-Meier curves showed that a high D-dimer level at D0 and tumor diameter ≥8 cm were associated significantly with worse overall survival (OS) (P<0.05). Multivariate Cox regression analyses revealed a high D-dimer level at D0 (hazard ratio, 3.92; 95% confidence interval, 1.756-5.804; P=0.000) was an independent unfavorable prognostic factor. The chi-square test showed ΔD to be associated significantly with tumor necrosis. Analyses of ROC curves showed the D-dimer level at D0 and ΔD had better ability compared to that at D1 to discriminate the response to neoadjuvant chemotherapy.
The D-dimer level was correlated with the prognosis and response to chemotherapy in patients with stage-IIB high-grade osteosarcoma of the limb. The D-dimer level may serve as a risk factor of the response to chemotherapy and prognosis of localized osteosarcoma.
本回顾性研究探讨血浆D-二聚体水平在骨肉瘤中的临床价值。
我们测量了103例IIB期肢体高级别骨肉瘤患者新辅助化疗前（D0）的血浆D-二聚体水平以及四个疗程新辅助化疗后（D1）的血浆D-二聚体水平。D-二聚体水平的变化（ΔD）定义为D1减去D0。采用卡方检验比较分类变量。进行受试者工作特征（ROC）曲线分析以确定D0、D1和ΔD的最佳截断点。计算D0、D1和ΔD的ROC曲线下面积（AUC）以评估它们在监测新辅助化疗反应（肿瘤坏死）方面的鉴别能力。根据Kaplan-Meier分析生成生存曲线，并使用对数秩检验进行比较。进行单因素分析和多因素分析以确定独立的预后因素。
Kaplan-Meier曲线显示，D0时D-二聚体水平高和肿瘤直径≥8 cm与总体生存率（OS）显著较差相关（P<0.05）。多因素Cox回归分析显示，D0时D-二聚体水平高（风险比，3.92；95%置信区间，1.756 - 5.804；P = 0.000）是一个独立的不良预后因素。卡方检验显示ΔD与肿瘤坏死显著相关。ROC曲线分析显示，与D1时相比，D0时的D-二聚体水平和ΔD在鉴别新辅助化疗反应方面具有更好的能力。
D-二聚体水平与IIB期肢体高级别骨肉瘤患者的预后及化疗反应相关。D-二聚体水平可能是局部骨肉瘤化疗反应和预后的一个危险因素。
